Archives: Medical Student Finals

MSFinals-1071

A 55-year-old man with a history of hypertension and type 2 diabetes presents to the Emergency department with complaints of central chest pain that radiates down his left arm. He is currently taking ramipril, metformin, atorvastatin, and gliclazide. On examination, his blood pressure is 129/72 mmHg, and his pulse is 81. Bibasal crackles are heard on auscultation of his chest.

The following investigations were conducted:
– Haemoglobin: 138 g/L (130-180)
– White cell count: 8.9 ×109/L (4-11)
– Platelet: 197 ×109/L (150-400)
– Sodium: 141 mmol/L (135-146)
– Potassium: 4.1 mmol/L (3.5-5)
– Creatinine: 123 µmol/L (79-118)
– Glucose: 12.3 mmol/L (<7.0)
– ECG: Anterolateral ST depression

The patient is given sublingual GTN. What is the next most appropriate therapy?

MSFinals-1072

A 16-year-old male presents with delayed pubertal development and a history of impaired sense of smell. He has a height on the 90th centile and weight on the 95th centile. There is no pubertal development in his external genitalia and his testicular volumes are 3 mL bilaterally. Upon investigation, his plasma luteinising hormone and follicle stimulating hormone levels are both 1.0 U/L (1-10), while his serum testosterone level is 2.0 pmol/L (9-33). His free T4 level is 20 pmol/L (10-22) and his plasma thyroid stimulating hormone level is 3.2 mU/L (0.4-5). A CT brain scan shows no abnormalities. What is the most likely diagnosis?

MSFinals-1032

A 16-year-old boy with an 8-year history of type I diabetes presents to the Emergency Department (ED) with a 24-hour history of vomiting. He tested his glucose and ketones at home and they were both high, glucose 30 mmol/L, ketones 3 mmol/L, so he attended the ED. He admits to omitting his insulin frequently. He appears dehydrated, has ketotic fetor, BP 112/76 mmHg, pulse 108 beats per minute, temp 37 degrees, oxygen saturations 98% on room air. Clinical examination is otherwise normal. The following are his laboratory investigations:
Test Result Normal range
pH 7.2 7.35–7.45
Ketones 3 mmol/l < 0.6 mmol/l
Glucose 28 mmol/l 3.5–5.5 mmol/l
Bicarbonate 11 mmol/l 24–30 mmol/l
Base excess -5 mEq/l −2 to +2 mEq/l
C-reactive protein (CRP) 3 mg/l 0–10 mg/l
What is required to make a diagnosis of diabetic ketoacidosis in this patient?

MSFinals-1033

A 28-year-old woman is referred by her general practitioner due to irregular and unpredictable menstrual cycle and headaches. Magnetic resonance imaging of the brain shows a midline lesion. Further investigations reveal that her prolactin level is 2314 ng/ml (2–29 ng/ml). To reduce the prolactin level, which mediator is manipulated for medical treatment?

MSFinals-1034

A 26-year-old professional athlete is being evaluated at the Endocrinology Clinic for presenting symptoms of low mood, decreased energy, and difficulty in preserving muscle mass. The patient also reports dry skin and hair loss. As part of the diagnostic process, the doctor requests a glucagon stimulation test.
What is elevated after the glucagon stimulation test?

MSFinals-1035

A 38-year-old woman presents with complaints of fever, malaise and pain in the neck, particularly when swallowing. She reports having had a viral respiratory infection a week ago. Upon examination, an enlarged thyroid, heart palpitations and excessive sweating are noted. Further tests reveal elevated ESR, leukocytosis, thyroid antibodies and low TSH levels. Additionally, a radionuclide thyroid uptake test shows decreased iodide uptake. What is the most probable diagnosis?

MSFinals-1036

A 66-year-old man visits his primary care physician for his annual check-up, reporting constant fatigue and thirst. He has a medical history of hypertension, hyperlipidemia, and obesity. The doctor orders a screening for type II diabetes and the results are as follows:
Test Result Normal Range
HbA1C 48 mmol/mol < 53 mmol/mol (<7.0%)
Fasting plasma glucose 7.2 mmol/l < 7 mmol/l
Glomerular filtration rate (GFR) 90 ml/min > 90 ml/min
Which of the following is included in the diagnostic criteria for type II diabetes?

MSFinals-1038

A 35-year-old male is scheduled for his annual diabetic review. During the examination, it is noted that his body mass index has increased to 31.5 kg/m2. How do you calculate body mass index?

MSFinals-1039

What test is utilized to examine for primary adrenal insufficiency, also known as Addison’s disease?